Influence of risk factors on the long-term survival of oral rehabilitation with extra-narrow implants: a retrospective study

MARCANTONIO JUNIOR, Elcio; SARTORI, Ivete Aparecida de Mattias; VIANNA, Camila Pereira; ROCHA, Roberta Schroder; CALDAS, Waleska; TROJAN, Larissa Carvalho

doi:10.1590/1678-7757-2022-0089

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Brasil

Journal of Applied Oral Science

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Original Article • J. Appl. Oral Sci. 30 • 2022 • https://doi.org/10.1590/1678-7757-2022-0089 copy

Influence of risk factors on the long-term survival of oral rehabilitation with extra-narrow implants: a retrospective study

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

This study aimed to retrospectively collect clinical data to evaluate the influence of possible risk factors on the long-term success of implant treatment with extra-narrow (2.9 mm diameter) implants in a daily dental practice setting.

Methodology

Data were collected from records of patients who received at least one extra-narrow implant from 2012 to 2017, regarding implant survival, prosthesis survival, patient characteristics, and implant characteristics. The association between the dependent variables “implant survival”, “prosthesis survival,” and “adverse events” related to patient and implant characteristics was statistically evaluated by chi-square tests. Moreover, implant and prosthesis survival were analyzed by Kaplan-Meier survival curves.

Results

The sample was constituted of 58 patients (37 women and 21 men) with a mean age of 54.8 years old (SD: 12.5), followed up for up to eight years. In total, 86 extra-narrow implants were placed within this sample. Four implants were lost, resulting in an implant survival rate of 95.3%. A total of 55 prostheses were inserted and only one (1.8%) was lost, resulting in a prosthesis survival rate of 98.2%. The mean implant and prosthesis survival time was, respectively, 7.1 years and 6.3 years, according to the Kaplan-Meier survival analysis. A correlation was found between smoking and implant loss, which makes implant loss eight times more likely to occur in smokers than non-smokers. A significant association was also found between prosthesis loss and previous need of prosthesis repair. However, it was not considered clinically relevant. No association was found between the occurrence of adverse events and later implant or prosthesis loss.

Conclusion

High implant and prosthesis survival rates were found in the long term for treatment with extra-narrow implants. Moreover, a significant correlation between smoking and implant loss was observed.

Prostheses and implants; Survival rate; Risk factors; Smokers

Implant loss?		Yes		No		Total	OR (95% CI)	p-value
		N	%	N	%	N
Sex	Woman	4	6.6	57	93.4%	61	ƚ	0.246
Sex	Man	0	0.0	25	100.0%	25	(ref.)
Presence of thyroid dysfunction?	Yes	1	25.0	3	75.0%	4	8.8 (0.7–111.3)	0.176
Presence of thyroid dysfunction?	No	3	3.7	79	96.3%	82	(ref.)
Presence of coagulation disorders?	Yes	0	0.0	3	100.0%	3	ƚ	0.894
Presence of coagulation disorders?	No	3	3.8	77	96.2%	80	(ref.)
Presence of poor healing capacity?	Yes	0	0.0	1	100.0%	1	ƚ	0.964
Presence of poor healing capacity?	No	3	3.7	79	96.3%	82	(ref.)
Regular steroid use?	Yes	0	0.0	1	100.0%	1	ƚ	0.953
Regular steroid use?	No	4	4.8	80	95.2%	84	(ref.)
Previous radiotherapy in the head/neck?	Yes	0	0.0	1	100.0%	1	ƚ	0.953
Previous radiotherapy in the head/neck?	No	4	4.8	80	95.2%	84	(ref.)
Bisphosphonate therapy?	Yes	0	0.0	3	100.0%	3	ƚ	0.864
Bisphosphonate therapy?	No	4	4.9	78	95.1%	82	(ref.)
Psychological limitations?	Yes	0	0.0	17	100.0%	17	ƚ	0.402
Psychological limitations?	No	4	5.9	64	94.1%	68	(ref.)
Presence of bone metabolism disorders?	Yes	0	0.0	4	100.0%	4	ƚ	0.822
Presence of bone metabolism disorders?	No	4	4.9	77	95.1%	81	(ref.)
Smoking?	Yes	2	18.2	9	81.8%	11	8.0 (1.0–63.9)	0.024*
Smoking?	No	2	2.7	72	97.3%	74	(ref.)

Implant loss?		Yes		No		Total	OR (95% CI)	p-value
		N	%	N	%	N
Implant length	10 mm	0	0.0%	17	100.0%	17	ƚ
	12 mm	3	7.7%	36	92.3%	39	2.5 (0.2–22.8)	0.857
	14 mm	1	3.6%	27	96.4%	28	(ref)
Region of implant placement	Lower canines	0	0.0%	4	100.0%	4	ƚ
	Lower central incisors	1	2.9%	34	97.1%	35	0.2 (0.0–3.2)	0.745
	Lower molars	0	0.0%	3	100.0%	3	ƚ
	Lower premolars	0	0.0%	7	100.0%	7	ƚ
	Upper canines	0	0.0%	1	100.0%	1	ƚ
	Upper lateral incisors	2	10.5%	17	89.5%	19	0.7 (0.0–9.3)	0.794
	Upper premolars	1	14.3%	6	85.7%	7	(ref)
	Others	0	0.0%	10	100.0%	10	ƚ
Insertion torque (N.cm)	10–35	1	4.5%	21	95.5%	22	0.6 (0.0–5.8)	0.636
Insertion torque (N.cm)	36–60	3	7.7%	36	92.3%	39	(ref)
Prosthesis type	Multi-unit fixed prosthesis	0	0.0%	42	100.0%	42	ƚ	ƚ
	Overdenture	0	0.0%	13	100.0%	13	ƚ
	Single-unit prosthesis	1	4.0%	24	96.0%	25	(ref)
Time until loading	Immediate loading	0	0.0%	40	100.0%	40	ƚ
	1–4 months	1	33.3%	2	66.7%	3	0.5 (0.0–8.9)	0.638
	5–12 months	0	0.0%	26	100.0%	26	ƚ
	> 12 months	0	0.0%	11	100.0%	11	ƚ
	Not loaded	3	50.0%	3	50.0%	6	(ref)
Final prosthesis retention	Cemented	0	0.0%	15	100.0%	15	ƚ	ƚ
	Overdenture	0	0.0%	12	100.0%	12	ƚ
	Screwed	0	0.0%	19	100.0%	19	(ref)
Peri-implant bone loss?	Yes, more than 1.5 mm	1	16.7%	5	83.3%	62	3.5 (0.3–40.6)	0.311
Peri-implant bone loss?	No	3	5.4%	53	94.6%	56	(ref)
Any prosthesis repair?	Yes	0	0.0%	2	100.0%	2	ƚ	ƚ
Any prosthesis repair?	No	0	0.0%	48	100.0%	48	(ref)

Prosthesis loss?		Yes		No		Total		p-value
		N	%	N	%	N	%
Sex	Woman	0	0.0%	30	100.0%	30	100.0%	0.072
Sex	Man	1	5.0%	19	95.0%	20	100.0%
Presence of thyroid dysfunction?	Yes	0	0.0%	2	100.0%	2	100.0%	0.824
Presence of thyroid dysfunction?	No	1	2.1%	47	97.9%	48	100.0%
Presence of coagulation disorders?	Yes	0	0.0%	2	100.0%	2	100.0%	0.861
Presence of coagulation disorders?	No	1	2.2%	45	97.8%	46	100.0%
Presence of poor healing capacity?	Yes	0	0.0%	0	0.0%	0	0.0%	0.952
Presence of poor healing capacity?	No	1	2.1%	47	97.9%	48	100.0%
Presence of incomplete jawbone growth?	Yes	0	0.0%	0	0.0%	0	0.0%	0.783
Presence of incomplete jawbone growth?	No	1	2.0%	49	98.0%	50	100.0%
Regular steroid use?	Yes	0	0.0%	0	0.0%	0	0.0%	0.953
Regular steroid use?	No	1	2.0%	48	98.0%	49	100.0%
Previous radiotherapy in the head/neck?	Yes	0	0.0%	1	100.0%	1	100.0%	0.953
Previous radiotherapy in the head/neck?	No	1	2.1%	47	97.9%	48	100.0%
Bisphosphonate therapy?	Yes	0	0.0%	1	100.0%	1	100.0%	0.864
Bisphosphonate therapy?	No	1	2.1%	47	97.9%	48	100.0%
Psychological limitations?	Yes	0	0.0%	8	100.0%	8	100.0%	0.402
Psychological limitations?	No	1	2.4%	40	97.6%	41	100.0%
Presence of bone metabolism disorders?	Yes	0	0.0%	2	100.0%	2	100.0%	0.822
Presence of bone metabolism disorders?	No	1	2.1%	46	97.9%	47	100.0%
Smoking?	Yes	0	0.0%	3	100.0%	3	100.0%	0.568
Smoking?	No	1	2.2%	45	97.8%	46	100.0%

Prosthesis loss?		Yes		No		Total		p-value
		N	%	N	%	N	%
Implant length	10 mm	0	0.0%	11	100.0%	11	100.0%	0.383
	12 mm	1	5.9%	16	94.1%	17	100.0%
	14 mm	0	0.0%	21	100.0%	21	100.0%
	15 mm	0	0.0%	0	0.0%	0	0.0%
Region of implant placement	Lower canines	0	0.0%	1	100.0%	1	100.0%	0.972
	Lower central incisors	1	4.5%	21	95.5%	22	100.0%
	Lower molars	0	0.0%	2	100.0%	2	100.0%
	Lower premolars	0	0.0%	3	100.0%	3	100.0%
	Upper canines	0	0.0%	0	0.0%	0	0.0%
	Upper lateral incisors	0	0.0%	9	100.0%	9	100.0%
	Upper premolars	0	0.0%	4	100.0%	4	100.0%
	Others	0	0.0%	9	100.0%	9	100.0%
Insertion torque (N.cm)	10–35	0	0.0%	15	100.0%	15	100.0%	0.605
Insertion torque (N.cm)	36–60	1	4.3%	22	95.7%	23	100.0%
Healing	Yes	0	0.0%	24	100.0%	24	100.0%	0.520
Healing	No	1	3.8%	25	96.2%	26	100.0%
Prosthesis type	Multi-unit fixed prosthesis	0	0.0%	22	100.0%	22	100.0%	0.338
	Overdenture	0	0.0%	12	100.0%	12	100.0%
	Single-unit prosthesis	1	6.2%	15	93.8%	16	100.0%
Time between implant and prosthesis placement	Immediate loading	1	3.0%	32	97.0%	33	100.0%	0.893
	1–4 months	0	0.0%	14	100.0%	14	100.0%
	5–6 months	0	0.0%	3	100.0%	3	100.0%
Final prosthesis retention	Cemented	1	6.7%	14	93.3%	15	100.0%	0.348
	Overdenture	0	0.0%	12	100.0%	12	100.0%
	Screwed	0	0.0%	19	100.0%	19	100.0%
Any prosthesis repair?	Yes	1	50.0%	1	50.0%	2	100.0%	0.040*
Any prosthesis repair?	No	0	0.0%	48	100.0%	48	100.0%
Peri-implant bone loss?	Yes, more than 1.5 mm	0	0.0%	2	100.0%	2	100.0%
Peri-implant bone loss?	No	0	0.0%	43	100.0%	43	100.0%

Any adverse event occurred after surgery?		Yes		No		Total		OR (CI 95%)	p-value
		N	%	N	%	N	%
Sex	Woman	1	1.6%	60	98.4%	61	100.0%	0.1 (0.0–1.2)	0.072
Sex	Man	3	12.0%	22	88.0%	25	100.0%	(ref.)
Presence of thyroid dysfunction?	Yes	0	0.0%	4	100.0%	4	100.0%	ƚ	0.824
Presence of thyroid dysfunction?	No	4	4.9%	78	95.1%	82	100.0%	(ref.)
Presence of coagulation disorders?	Yes	0	0.0%	3	100.0%	3	100.0%	ƚ	0.861
Presence of coagulation disorders?	No	4	5.0%	76	95.0%	80	100.0%	(ref.)
Presence of poor healing capacity?	Yes	0	0.0%	1	100.0%	1	100.0%	ƚ	0.952
Presence of poor healing capacity?	No	4	4.9%	78	95.1%	82	100.0%	(ref.)
Presence of incomplete jawbone growth?	Yes	0	0.0%	5	100.0%	5	100.0%	ƚ	0.783
Presence of incomplete jawbone growth?	No	4	4.9%	77	95.1%	81	100.0%	(ref.)
Regular steroid use?	Yes	0	0.0%	1	100.0%	1	100.0%	ƚ	0.953
Regular steroid use?	No	4	4.8%	80	95.2%	84	100.0%	(ref.)
Previous radiotherapy in the head/neck?	Yes	0	0.0%	1	100.0%	1	100.0%	ƚ	0.953
Previous radiotherapy in the head/neck?	No	4	4.8%	80	95.2%	84	100.0%	(ref.)
Bisphosphonate therapy?	Yes	0	0.0%	3	100.0%	3	100.0%	ƚ	0.864
Bisphosphonate therapy?	No	4	4.9%	78	95.1%	2	100.0%	(ref.)
Psychological limitations?	Yes	0	0.0%	17	100.0%	17	100.0%	ƚ	0.402
Psychological limitations?	No	4	5.9%	64	94.1%	68	100.0%	(ref.)
Presence of bone metabolism disorders?	Yes	0	0.0%	4	100.0%	4	100.0%	ƚ	0.822
Presence of bone metabolism disorders?	No	4	4.9%	77	95.1%	81	100.0%	(ref.)
Smoking?	Yes	0	0.0%	11	100.0%	11	100.0%	ƚ	0.568
Smoking?	No	4	5.4%	70	94.6%	74	100.0%	(ref.)

Any adverse event occurred after surgery?		Yes		No		Total		OR (95% CI)	p-value
		N	%	N	%	N	%
Implant length	10 mm	0	0.0%	17	100.0%	17	100.0%	ƚ
	12 mm	2	5.1%	37	94.9%	39	100.0%	0.7 (0.1–5.3)	0.733
	14 mm	2	7.1%	26	92.9%	28	100.0%	(ref.)
Region of implant placement	Lower canines	0	0.0%	4	100.0%	4	100.0%	ƚ
	Lower central incisors	3	8.6%	32	91.4%	35	100.0%	1.7 (0.2–17.4)	0.660
	Lower molars	0	0.0%	3	100.0%	3	100.0%	ƚ
	Lower premolars	0	0.0%	7	100.0%	7	100.0%	ƚ
	Upper canines	0	0.0%	1	100.0%	1	100.0%	ƚ
	Upper lateral incisors	1	5.3%	18	94.7%	19	100.0%	(ref.)
	Upper premolars	0	0.0%	7	100.0%	7	100.0%	ƚ
	Others	0	0.0%	10	100.0%	10	100.0%	ƚ
Insertion torque (N.cm)	10–35	0	0.0%	22	100.0%	22	100.0%	ƚ	0.158
Insertion torque (N.cm)	36–60	4	10.3%	35	89.7%	39	100.0%	(ref.)
Healing	Yes	3	7.0%	40	93.0%	43	100.0%	3.1 (0.3–30.8)	0.317
Healing	No	1	2.4%	41	97.6%	42	100.0%	(ref.)
Prosthesis type	Multi-unit fixed prosthesis	2	4.8%	40	95.2%	42	100.0%	0.6 (0.1–4.4)	0.591
	Overdenture	0	0.0%	13	100.0%	13	100.0%	ƚ
	Single-unit prosthesis	2	8.0%	23	92.0%	25	100.0%	(ref.)
Final prosthesis retention	Cemented	1	6.7%	14	93.3%	15	100.0%	(ref.)	0.348
	Overdenture	0	0.0%	12	100.0%	12	100.0%	ƚ
	Screwed	0	0.0%	19	100.0%	19	100.0%	ƚ
Any prosthesis repair was reported?	Yes	1	50.0%	1	50.0%	2	100.0%	(ref.)	0.055
Any prosthesis repair was reported?	No	0	0.0%	48	100.0%	48	100.0%	ƚ
Periimplant bone loss?	Yes, more than 1.5 mm	1	16.7%	5	83.3%	6	100.0%	(ref.)
Periimplant bone loss?	No	0	0.0%	56	100.0%	56	100.0%	ƚ

	Mean survival rate (years)	Standard deviation	95% inferior confidence interval	95% superior confidence interval	p-valor between factors
All implants	7.098	0.197	6.713	7.484	-
All prostheses	6.282	0.125	6.037	6.527	-
Implants in smokers	3.765	0.394	2.99	4.537	0.002*
Implants in non-smokers	7.255	0.17	6.92	7.588	-

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[1] Corresponding address: Waleska Caldas Faculdade ILAPEO - Rua Jacarezinho, 656 - Mercês - 80710-150 - Curitiba - PR, Brasil . Phone: +55 (41) 987501635 e-mail: waleska.caldas@alumni.usp.br